Complaint For Violation Of Civil Rights

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF TENNESSEE AT ) ) ) (Enter above the NAME of the plaintiff in this action.) ) v. ) ) ) ) (Enter above the NAME of each defendant in this action.) COMPLAINT FOR VIOLATION OF CIVIL RIGHTS (42 U.S.C. Section 1983) I. PREVIOUS LAWSUITS A. Have you begun other lawsuits in state or federal court dealing with the same facts involved in this action or otherwise relating to your imprisonment? YES( ) NO( ) B. If your answer to A is YES, describe the lawsuit in the space below. (If there is more than one lawsuit, describe the additional lawsuits on another piece of paper, using the same outline.) 1. Parties to the previous lawsuit: Plaintiffs Defendants <<<<<<<<<********>>>>>>>>>>>>> 2 2. COURT (If federal court, name the district; if state court, name the county): 3. DOCKET NUMBER: 4. Name of Judge to whom case was assigned: 5. Disposition: (For example: Was the case dismissed? Was it appealed? Is it still pending?) 6. Approximate date of filing lawsuit: 7. Approximate date of disposition: II. PLACE OF PRESENT CONFINEMENT: A. Is there a prisoner grievance procedure in this institution? YES ( ) NO ( ) B. Did you present the facts relating to your complaint in the state prisoner grievance procedure? YES ( ) NO ( ) C. If your answer is YES, 1. What steps did you take? 2. What was the result? D. If your answer to B is NO, explain why not. E. If there is no prison grievance procedure in the institution, did you complain to prison authorities? YES ( ) NO ( ) F. If your answer is YES, <<<<<<<<<********>>>>>>>>>>>>> 3 1. What steps did you take? 2. What was the result? 2 III. PARTIES (In item A below, place your name in the first blank and place your present address in the second blank. Do the same for any additional plaintiffs.) A. Name of plaintiff: Present address: Permanent home address: Address of nearest relative: (In item B below, place the FULL NAME of the defendant in the first blank, his official position in the second blank, and his place of employment in the third blank. Use item C for the additional names, positions, and places of employment of any additional defendants.) B. Defendant: Official position: Place of employment: C. Additional Defendants: IV. STATEMENT OF CLAIM (State here as briefly as possible the FACTS of your case.<<<<<<<<<********>>>>>>>>>>>>> 4 Describe how EACH defendant is involved. Include also the names of other persons involved, dates and places. DO NOT give any legal arguments or cite any cases or statutes. If you intend to allege a number of related claims, number and set forth each claim in a separate paragraph. Use as much space as you need. Attach extra sheets, if necessary.) 3 STATEMENT OF CLAIM (Continued) <<<<<<<<<********>>>>>>>>>>>>> 5 4 V. RELIEF (State BRIEFLY exactly what you want the Court to do for you. Make No legal arguments. Cite No cases or statutes.) SIGNED THIS DAY OF , 19 . SIGNATURE OF PLAINTIFF <<<<<<<<<********>>>>>>>>>>>>> 6I DECLARE UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. DATE SIGNATURE OF PLAINTIFF YOU ARE RESPONSIBLE FOR KEEPING THE COURT INFORMED IMMEDIATELY OF ANY ADDRESS CHANGES. FAILURE TO PROVIDE YOUR CORRECT ADDRESS TO THIS COURT WITHIN TEN (10) DAYS FOLLOWING ANY CHANGE OF ADDRESS WILL RESULT IN THE DISMISSAL OF THIS ACTION. 5